10 June 2009

Dr Grumble has previously touched upon the issue of how doctors may reach a diagnosis, how they may get it wrong and how little is known about the heuristic processes that govern their thinking. Even good leaders can get things wrong. Here's a video outlining how this can happen:

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Now this video is plainly a plug for a book. And what's wrong with that? It is a book Dr Grumble would like to read but he hasn't got time. Not at the moment anyway. So he is going to see what lessons can be learnt from this short video clip. It seems there are many.

To try and prevent bad leadership decisions the authors warn of red flags. One of the red flags is a misleading experience. This is a red flag Dr Grumble has spotted in relation to some major decisions which have altered the whole direction of the NHS. He has, for example, pointed out the misleading experience which has driven our misguided leaders to put a market into the NHS. The misleading experience comes from the high street. You go to one shop. They are rude to you. You never go back and shop elsewhere. While you are in the next shop something very attractively packaged catches your eye. You don't really want it but you buy it all the same. They are not perfect but markets work well enough in the high street. That is the misleading experience. Because, as Dr Grumble and many others have pointed out, markets do not work well for healthcare. It is actually quite difficult to go to another hospital when you are acutely ill and you don't want to be sold treatment you do not really need while you are there. Elderly sick people just do not want to shop around. They don't have the information to do so. And loads of websites and stats are never going to give that to them.

Now let's take the example of Connecting for Health, the wonderful national programme for IT. What's the misleading experience here? It is the wonders of computers and the web. Dr G agrees the web is wonderful. He is using it now far away from the UK to deliver this missive to the whole wide world. It is marvellous. Managing patients is about managing information and that is what the web is all about. So when Tony Blair sat on that sofa for half an hour and decided on spending tens of billions of taxpayers' money on a super-duper IT system for the NHS you can see where he was coming from. But he was coming from a misleading experience. Dr Grumble is in love with the wonders of the web but give him a computer alongside a patient and instead of speeding things up it slows him down. Of course computers are the future and one day will help doctors manage patients but the experience of day-to-day use of the internet and email was a misleading one. Just why is not something Dr Grumble will go into here but many others (not just in the UK) have pointed out the difficulties of using ill-designed computer systems in a busy clinic or hospital ward. We will be there one day but Tony Blair couldn't see that it would take much longer than he envisaged because of his misleading experience and his political need for a quick result.

There are other intriguing ideas in this video. How one wonders do emotion, gut feelings and inappropriate self interest apply to Tony Blair? And what about inappropriate attachments? What are they? In the case of Blair and the Gulf War could one have been George Bush? Could another have been his religious conviction? Or was it his misleading prejudgement that caused the loss of so many innocent lives?